(159) Incidence of Invasive Fungal Disease and Viral Infections in Pediatric Patients Treated with Targeted Agents for Graft versus Host Disease

Poster Abstract: Background/rationale: Graft-versus-host disease (GvHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Conventional therapies are associated with adverse effects (AEs).Targeted agents (e.g.. ruxolitinib, belumosudil, ibrutinib) improve clinical response and also have lessened risk for AEs in steroid-refractory GvHD. The risk for fungal disease and viral infections with targeted agents is not well studied.

Objective(s): The study objective is to characterize the rate of proven or probable invasive fungal infection (IFI) and viral infections in pediatric patients following GvHD treatment with targeted agents in combination with other immunosuppressives.

Methods: This is an IRB-approved, retrospective cohort study of pediatric patients (≤21 years of age) who received HSCT and had GvHD (acute or chronic) treated with belumosudil, ibrutinib, and ruxolitinib monotherapy or in combination with other immunosuppressive therapies at a tertiary cancer center between January 2016 and June 2023. Demographic, transplant, and GvHD characteristics were extracted from patient records. In addition, dose and duration of targeted agents/concomitant steroids and antiviral/antifungal prophylaxis were collected. A proven IFI was pathology proven whereas a probable IFI was based on positive microbiologic or serologic data. Viral infections included reactivation or viral disease requiring therapy due to cytomegalovirus (CMV), herpes simplex virus (HSV), varicella zoster virus (VZV), Epstein-Barr virus (EBV), adenovirus (ADV) and other documented viral disease.

Results: We identified 260 HCT recipients and 20 (7.6%) patients developed GvHD and received a targeted agent. The analysis is ongoing and results are pending.

Discussion/conclusion: Pending

References (must also be included in final poster): 1.Zhang L, Yu J, Wei W. Advance in Targeted Immunotherapy for Graft-Versus-Host Disease. Front Immunol. 2018;9:1087. Published 2018 May 16. doi:10.3389/fimmu.2018.01087https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4234095/
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